Sensory Organs EO 003.01 Part 29

Overview of Lesson (Insert Dari) Opthamologicals Eye anti-infectives Eye anti-inflammatories Anti-glaucoma preparations and miotics Mydriatics and cycloplegics Eye decongestants and anti-allergics Otologicals Insert Dari

What I need to know as a pharmacy technician (Insert Dari) In this lecture we will cover the drugs listed in the ANA Formulary which are classified according to the ATC system under (S) Sensory Organs For each of these medications/classes students must obtain an understanding of: (1) Mechanism of Action (2) Indications (Uses) (3) Efficacy (4) Side Effects Insert Dari

Opthalmologicals (Insert Dari)

Disorders of the Eye (Insert Dari) Conjunctivitis (Pink Eye) – Infection of the conjunctiva (very outer layer of the eye) caused by bacteria, viruses or in rare cases fungi. Blepharitis - inflammation of the eyelid, can be caused by bacteria. Hordeolum (sty) - infection of an eyelash gland.

Eye Anti-infectives (Insert Dari) Mechanism of Action Stops bacterial infections in the same manner as when taken orally. Fluoroquinolones: Moxifloxacin/Ciprofloxacin Interfere with DNA synthesis Aminoglycosides: Gentamicin Interfere with protein synthesis. Sulfacetamide – interferes with folic acid synthesis Polymixin/Bacitracin – damages cell membrane/ inhibits cell wall synthesis Insert Dari

Eye Anti-infectives (Insert Dari) Povidine and Polyvinyl alcohol Povidone is known to be a powerful germicidal agent effective against a wide range of bacteria, viruses, fungi, protozoa, and spores. Indications (Use) Conjunctivitis (infection of the outer layer of they eye). Generally less serious infections (pink eye) are treated with polymixin/gramacidin . Depending on the infective agent suspected more serious infections will be treated as appropriate with the other antibiotics.

Eye Anti-infectives (Insert Dari) Side Effects Change in eyesight (blurry vision for a few moments after instilling the eyedrops). Eye pain Irritation Burning Stinging

Eye Anti-infectives (Insert Dari) Important Points How to properly instill eye drops will be covered in detail during EO 003.03. Important for patients to wash hands before and after use. Also important to not touch the tip of the eyedropper as you may contaminate the bottle. If infection doesn’t clear up in 48 to 72 hrs the patient should see a physician as they may require a different antibiotic. Can be stored at room temperature.

Steroid Eye Drops : Prednisolone (Insert Dari) Mechanism of action Decreases inflammation and irritation. Indications (Use) Conjunctivitis Corneal injuries Eye Swelling Side Effects • Short-term pain after use. • Cataracts or glaucoma with long-term use. May feel a burning or stinging sensation after instilling the eye drops. Insert Dari

Prednisolone (Eye drops) (Insert Dari) Important Points How to properly instill eye drops will be covered in detail during EO 003.03. Important for patients to wash hands before and after use. Also important to not touch the tip of the eyedropper as you may contaminate the bottle. Can be stored at room temperature. Patient should start to feel some benefit with a few hours of using the drops. Insert Dari

Combination Eye Drops (Anti-infective and Steroid) (Insert Dari) Mechanism of Action Kills bacteria that are causing an eye infection the steroid acts as an anti-inflammatory helping to reduce irritation and discomfort. Indication To treat an eye infection. Side Effects Short-term pain after use. • Cataracts or glaucoma with long-term use. May feel a burning or stinging sensation after instilling the eye drops Insert Dari

Combination Eye Drops (Anti-infective and Steroid) (Insert Dari) Important Points How to properly instill eye drops will be covered in detail during EO 003.03. Important for patients to wash hands before and after use. Also important to not touch the tip of the eyedropper as you may contaminate the bottle. If infection doesn’t clear up in 48 to 72 hrs the patient should see a physician as they may require a different antibiotic. Can be stored at room temperature. Insert Dari

Disorders of the Eye (Insert Dari) Glaucoma – increased intraocular pressure. This can permanently damage vision in the affected eye(s) and lead to blindness if left untreated.

Anti-glaucoma Preparations (Insert Dari) Mechanism of Action Decreased internal eye pressure Contracts eyeball iris Indication To treat glaucoma. Side Effects Pilocarpine: Eye irritation Blurred eyesight Lowered night vision May cause eyelashes to grow. Insert Dari

Anti-glaucoma Preparations (Insert Dari) Side Effects Timolol: Eye irritaiton Change in vision Important Points How to properly instill eye drops will be covered in detail during EO 003.03. Important for patients to wash hands before and after use. Also important to not touch the tip of the eyedropper as you may contaminate the bottle. Can be stored at room temperature. Insert Dari

Atropine Eye Drops (Insert Dari) Mechanism of Action Stops contraction of eyeball iris (dilation) Indication To treat swelling of the eye. To widen the pupil prior to an eye examination. Side Effects •Burning. •Stinging. •Eye irritation. •Blurred eyesight. •Bright lights may be bothersome. Insert Dari

Atropine Eye Drops (Insert Dari) Important Points How to properly instill eye drops will be covered in detail during EO 003.03. Important for patients to wash hands before and after use. Also important to not touch the tip of the eyedropper as you may contaminate the bottle. Can be stored at room temperature. Insert Dari

Cromolyn Eye Drops (Insert Dari) Mechanism of Action Decreases inflammation and irritation. Indication Allergies causing eye irritation. Side Effects Can cause irritation of the eye. Burning stinging sensation.

Cromolyn Eye Drops (Insert Dari) Important Points How to properly instill eye drops will be covered in detail during EO 003.03. Important for patients to wash hands before and after use. Also important to not touch the tip of the eyedropper as you may contaminate the bottle. Can be stored at room temperature. Should start to see an improvement in symptoms within 48-72 hrs.

Otologicals (Insert Dari)

Otitis Externa (Insert Dari) Otitis Externa - inflammation of the outer ear and ear canal (often occurs in swimmers). Treatment of inflammation and infection primarily involves use of topical agents. Otitis Media – inflammation of the middle ear should never be treated with topical agents. Insert Dari

Treatments for Otitis Externa (Insert Dari) Mechanism of Action Antibiotics- kill the bacteria/inhibit growth through various mechanisms. Boric Acid – increases the acidity of the inner ear preventing the bacteria from growing. Indications Otitis externa (infection of the outer ear and ear canal).

Treatments for Otitis Externa (Insert Dari) Side Effects Can cause irritation of the ear. Can cause dizziness Important Points Proper instillation of ear drops will be covered in EO 003.03. If symptoms do not improve within 48-72 hrs the patient should see their physician.

Questions? (Insert Dari)

In-class Assignment (Insert Dari) This assignment will consist of 3 questions which are to be completed individually. Once complete the instructor will review the answers with the class. Insert Dari

1. Match the following ophthalmologic agents with their indication (use). (Insert Dari) Atropine Timolol Polymixin/bacitracin eye drops Prednisolone Reduce inflammation and irritation Reduce eye pressure and can be used before an eye exam To treat an eye infection Glaucoma Insert Dari

1. Match the following ophthalmologic agents with their indication (use). (Insert Dari) Atropine (2) reduce eye pressure and can be used before an eye exam Timolol (4) glaucoma Polymixin/bacitracin eye drops (3) to treat an eye infection Prednisolone (1) reduce inflammation and irritation Insert Dari

2. When speaking to a patient regarding their eye drops all of the following information is important to tell them EXCEPT for? (Insert Dari) Wash your hands before an after using the eyedrops Do not touch the tip of the eyedropper to avoid contaminating the bottle. Be sure to store the eyedrops in the fridge. For antibacterial eye drops patients should begin to see improvement within 48 – 72 hrs. Insert Dari

2. Answer: When speaking to a patient regarding their eye drops all of the following information is important to tell them EXCEPT for? (Insert Dari) Wash your hands before an after using the eyedrops Do not touch the tip of the eyedropper to avoid contaminating the bottle. Be sure to store the eyedrops in the fridge. For antibacterial eye drops patients should begin to see improvement within 48 – 72 hrs. Insert Dari The majority of eye drops are NOT stored in the fridge be sure to check manufacture’s information prior to speaking with a patient. (Insert Dari)

3. True or False: Topical ear drops are a great option for treating otitis media. (Insert Dari)

3. True or False: Topical ear drops are a great option for treating otitis media (inner ear infections). (Insert Dari) Answer: False, topical ear drops are primarily used to treat infection of the outer ear and ear canal (otitis externa). They do not penetrate the inner ear well enough to treat otitis media.